Columbia  ©mtotsitp 

College  of  3Pf)2>stctang  anb  Hmrgeong 
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INTRODUCTORY  ADDRESS 


STUDENTS   IN   MEDICINE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


UNIVERSITY 


OF    THE    STATE     OP    NEW-YORK, 


DELIVERED  NOV.   6,   1839. 


By   JAMES  R.    MANLEY,   M.D. 

LECTURER  ON  OBSTETRICS  AND  THE  DISEASES  OF  WOMEN  AND  CHILDREN., 


NEW-YORK: 

PUBLISHED    BY    THE    STUDENTS. 
1839. 


INTRODUCTORY  ADDRESS 


STUDENTS   IN  MEDICINE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


UNIVERSITY 


OF    THE    STATE     OF    NEW-YORK. 


DELIVERED   NOV.   G,   1839- 


By   JAMES  R.  MANLEY,   M.D. 

IICTUB.ER  ON  OBSTETRICS  AND  THE  DISEASES  01   WOMEN  AND  CHlLDaEN, 


NE  W-YO  RE- 
PUBLISHED   BY   THE    STUDENTS 
1839. 


V  i. 


1 


H.  LUDWIG,  PRINTER, 
72  Vpsev-Ptrf.pt  N.  Y. 


■    X 


':/*  ' 


/* 


New- York,  November  II,  1839. 


of  rhysk 


Sir, 

At  a  meeting  of  the  Students  of  the  College  of  Physicians  and 
Surgeons,  held  on  the  9th  inst.,  the  undersigned  were  appointed  a  committee  to  request 
a  copy  of  your  very  able'ahd  appropriate  Introductory  Address  for  publication. 

YV«  take  great  pleasure  in  thus  conveying  to  you  the  wishes 
of  the  Class,  and  trust  that  you  will  find  it  convenient  to  comply  with  their  request. 
We  are,  Sir,  , 

Yours,  with  much  respect, 

A.  Cooke  Hull,  -* 


N.    T.   LlGHTBOURNE, 

D.  J.  McGowan, 

C.    H.    OaKLE5T, 

Johnson  Rabineau, 

D.VV.  C.Graham, 

James  R.  Greaxen,  Chairman, 

James  S.  Cooper,  Secretary. 


y  Comv:i,ttee. 


J 


To  f.  R.  Manley,  M.  D„ 

Professor  of  Obstetrics,  &.c» 


New-Yore,  November  13th,  1839. 


Gentlemen, 

Your  very  flattering  note,  of  yesterday's  date,  I  have  just 
received,  and  take  the  earliest  opportunity  to  reply  to  it.  You  have  a  reasonable 
claim  for  the  copy  of  my  introductory  address,  and  I  would  be  unreasonable  to  refuse  it. 
On  former  occasions  the  same  request  has  been  made,  and  I  have  invariably  one 
answer,  to  wit :  that  no  man  has  a  right  to  publish  orally,  that  which  he  would  be 
unwilling  to  print.  The  very  handsome  manner  in  which  it  is  solicited,  would  be  an 
additional  reason  if  any  were  necessary. 

As  soon  as  a  copy  can  be  prepared,  it  shall  be  at  your  service, 
as  the  one  from  which  I  read  is  a  first  draught,  and  it  might  be  difficult  for  the  printer 
to  decipher  it. 

I  am,  with  great  respect, 

Yours,  very  respectfully, 

JAMES  R.  MANLEY. 


To  Messrs.  A.  Cooke  Hull, 

"  (l  Jf#   T#    LlGHTBOURNE, 

"  "  D.  J.  McGowan, 

"  "  C.  H.  Oaklev, 

"  "  Johnson  Rabineau, 

"  "  D.  W.  C.  Graham, 

"  "  James  R.  Greacen,  Chairman. 

"        "  James  S.  Cooper,  Secretary. 


?  Committee. 


J 


K 


AN 


INTRODUCTORY   LECTURE. 

Medicine  is  that  branch  of  human  knowledge, 
which  has  for  its  object  an  inquiry  into  the  nature 
and  causes  of  diseases,  with  a  view  to  the  discovery 
and  adaptation  of  appropriate  remedies.  Man  is  so 
complex  and  delicate  in  his  structure  ;  the  life  which 
he  is  destined  to  lead  is  so  marked  by  vicissitudes, 
which  he  can  neither  control  nor  avoid ;  the  dangers 
to  which  he  is  subjected  are  so  imminent  and  yet  so 
concealed,  and  his  forecast  of  consequences  is  so 
limited  and  so  imperfect,  as  to  render  him  the  subject 
of  every  noxious  agent  calculated  not  only  to  peril 
his  existence,  but  to  make  him  the  victim  of  its  influ- 
ence :  that  it  is  a  matter  of  astonishment  he  lives  so 
long,  or  enjoys  so  much.  From  the  first  convulsive 
struggle  for  breathing  life,  to  the  last  faint  gasp  which 
marks  him  for  the  tomb,  there  is  a  continued  strife 
between  powers  which  bind  him  to  existence,  and 
powers  which  menace  his  destruction;  and  it  is  a  law 
of  his  nature  that  the  last  must  triumph.     To  defer 

or  procrastinate  that  event  to  its  utmost  period — to 
2 


permit  as  much  of  enjoyment,  and  to  enable  him  ta 
avoid  as  much  suffering,  so  far  as  that  suffering 
arises  from  physical,  as  distinct  from  moral  eauses,  is 
its  peculiar  province. 

From  the  necessity  and  extent  of  its  application,  it 
must  embrace  a  wide  field  of  observation,  require  an 
intimate  knowledge  of  the  structure  and  functions  of 
the  human  system,  both  in  health  and  disease,  and 
a  close  examination  of  the  analogies  which  obtain  in 
the  various  departments  of  natural  history.  Almost 
every  branch  of  science  is  pressed  into  its  service  and 
made  to  contribute  to  its  improvement ;  so  that  the 
education  of  the  well-instructed  physician  includes 
an  amount  of  acquirement  in  the  various  departments 
of  natural  science,  which  we  may  not  expect  to  find 
in  any  other  profession. 

So  wide  is  this  field  of  research  and  observation, 
and  so  various  the  sources  from  which  the  student 
must  derive  his  information,  that  it  has  not  only  been 
found  convenient,  but  absolutely  necessary,  to  divide 
the  science  into  distinct  departments ;  each  of  which 
is  important  in  itself,  while  all  combined  are  essen- 
tial to  constitute  a  whole  system,  with  which  he  must 
become  familiar,  before  he  can  lay  claim  to  the  cha- 
racter of  an  intelligent  and  successful  physician. 

In  this  school  of  medicine  the  division  of  the  studies 
has  been  made,  with  special  reference  to  the  eonve- 


nience  of  its  acquisition.  Anatomy  and  Physiology, 
Theory  and  Practice  of  Physic,  Materia  Medica  and 
Legal  Medicine,  Principles  and  Practice  of  Surgery, 
Chemistry  and  Botany,  are  all  taught  by  men  alike 
qualified,  both  by  the  measure  of  their  information, 
and  their  talent  to  communicate  it;  to  render  the 
several  courses  as  instructive  as  they  are  interesting. 

In  consequence  of  the  resignation  of  the  late  able 
and  intelligent  Professor  of  Midwifery  and  the  Dis- 
eases of  Women  and  Children,  the  direction  of  this 
course  of  study,  by  a  vote  of  the  Trustees  of  this 
Institution  has  been  assigned  to  me  ;  and  I  stand  be- 
fore you  in  the  character  of  a  public  lecturer  for  the 
first  time.  I  trust,  however,  that  I  enter  upon  its 
duties  with  a  full  knowledge  of  the  responsibilities 
of  the  charge,  and  a  full  determination  to  render  it  as 
easy  of  acquisition,  and  as  interesting  to  the  student 
as  can  consist  with  the  importance  of  the  subject  and 
my  own  measure  of  ability. 

I  cannot  allow  this  occasion  to  pass  without  an 
acknowledgment  to  Dr.  Delafield,  who  lately  occu- 
pied this  chair,  for  his  kindness  and  liberality  (mani- 
fested without  permitting  time  for  solicitation)  in 
offering  the  use  of  his  valuable  museum  for  the  illus- 
tration of  this  course  of  study.  I  beg  him  to  accept 
my  thanks,  and  on  behalf  of  the  Trustees  of  this 
School,  I  tender  him  theirs. 


8 

From  the  latitude  of  remark  usually  allowed  in 
introductory  addresses,  I  should  feel  warranted  in 
selecting  any  subject  connected  with  the  course  which 
was  calculated  to  interest  or  entertain ;  and  those 
would  probably  create  most  interest  in  a  mixed 
audience  which  admitted  most  scope  for  speculation. 
Such,  for  example,  as  the  doctrines  of  Generation, 
Superfcetation,  Foetal  nutrition,  &c,  all  of  which,  no 
matter  how  ably  they  might  be  discussed,  are  utterly 
destitute  of  any  practical  benefit.  I  have  preferred, 
therefore,  the  beaten  highways  of  acknowledged 
truth  to  the  devious  bye-paths  of  hypothetic  debate ; 
and  have  chosen  to  present  a  view  of  the  subjects 
which  I  have  been  appointed  to  teach,  some  of  the 
principles  upon  which  they  rest,  and  the  obvious 
duties  which  they  require.  I  do  not  flatter  myself 
that  their  novelty  will  entertain,  still  less  that  they 
will  amuse  ;  they  are  too  old  to  answer  the  one  pur- 
pose, too  hackneyed  for  the  other,  and  too  serious  to 
be  prostituted  to  either  ;  but  as  much  is  known  to  be 
true  which  is  not  properly  appreciated,  I  presume 
that  the  few  remarks  which  I  may  offer  will  not  be 
without  their  interest. 

The  course  of  instruction  upon  which  we  now  en- 
ter not  only  includes  the  treatment  of  the  gravid  and 
parturient  female,  but  the  treatment  of  the  diseases 
of  women  and  children :  under  which  head  are  com- 


prised  all  those  diseases  connected  with,  or  in  any 
manner  dependent  upon,  the  derangement  of  func- 
tions peculiar  to  the  female.  In  this  view  of  it,  it 
must  be  confessed  that  its  importance  is  much  mag- 
nified, for  it  would  not  be  difficult  to  shew  that  the 
fatality  from  this  class  of  diseases  immeasurably  ex- 
ceeds that  which  follows  from  the  diseases  and  acci- 
dents incident  to  the  pregnant  or  parturient  woman ; 
and  the  successful  treatment  of  them,  requires  a  more 
extensive  range  of  observation,  and  a  more  close  and 
intimate  knowledge  of  the  female  constitution,  than 
the  art  of  Midwifery  itself,  considered  apart  from  this 
relation. 

Every  qualified  Obstetrician  must,  from  the  nature 
of  his  vocation,  be  a  well-informed  physician,  for, 
with  the  exceptions  of  manual  and  instrumental 
operations,  or  what  is  "usually  styled  Operative  Mid- 
wifery, no  well-founded  distinction  can  be  estab- 
lished between  them.  The  education  of  the  one 
ought  to  be  the  education  of  the  other  ;  and  where 
they  are  not,  both  are  deficient.  The  study  of  every 
department  of  medical  science  is  essential  to  both, 
the  division  into  departments,  as  before  stated,  being 
created  only  to  facilitate  their  acquisition. 

Midwifery  is  that  branch  of  a  medical  education 
which  has  for  its  object  the  preservation  of  the  health 
of  the  gravid  female,  her  safe  delivery,  and  perfect 


10 

recovery  from  its  effects.  It  involves  a  knowledge 
of  every  branch  usually  taught  in  medical  schools, 
and  in  addition,  such  a  special  and  particular  know- 
ledge of  the  female  functions,  as  has  made  it  neces- 
sary to  consider  it  a  separate  and  independent  course 
of  study.  Its  importance  is  too  obvious  to  require  a 
laboured  recommendation;  for  whether  considered 
in  relation  to  the  interest  of  the  patient,  or  the  repu- 
tation of  the  physician,  no  part  of  a  medical  educa- 
tion has  higher  claims  to  the  attention  of  the  student. 
His  professional  character  is  so  intimately  connected 
with  his  successful  practice  of  this  art,  that  he 
will  find  it  is  impossible  to  maintain  the  confidence 
of  the  community,  if  he  be  deficient  in  this  single 
department.  His  professional  standing  in  all  other 
respects,  may  be  as  elevated  as  his  most  partial 
friends  may  desire,  but  failures  here,  in  public  opin- 
ion, admit  of  no  apology,  and  are  invariably  followed 
by  a  retribution  which  will  destroy  all  his  future 
prospects. 

As  a  practised  art,  it  must  be  almost  as  old  as  crea- 
tion, but  there  is  very  little  in  its  early  history  to 
flatter  the  pride  of  science ;  there  is  still  less  to  imi- 
tate ;  and  really  nothing  which  a  humane  mind  can 
contemplate  with  complacency.  The  ancient  prac- 
titioners of  this  art  had  no  principles  to  govern  them ; 
nor  could  they  have,  in  the  absence  of  that  elemen- 


11 

tary  knowledge  which  alone  can  serve  for  its  founda- 
tion. Of  Obstetric  Anatomy  they  were  lamentably 
ignorant,  and  their  Physiology  was  conjectural.  They 
appear  to  have  given  attention  to  it,  only  inciden- 
tally, for  the  practice  was  confined  almost  exclusively 
to  the  female  sex.  They  had  little  opportunity  of 
improving  a  science  to  which  they  did  not  profes- 
sionally devote  themselves;  and  from  the  time  of 
Hippocrates  to  Harvey,  and  perhaps  long  anterior  to 
it,  it  might  with  truth  be  said,  that  the  curse  pro- 
nounced upon  our  first  mother,  and  entailed  upon  all 
her  succeeding  daughters,  lost  nothing  of  its  severity 
or  bitterness  by  the  officious  interference  of  the  male 
practitioner. 

All  Midwifery  to  be  found  in  ancient  authors  down 
to  the  time  of  Ambrose  Pare,  (who  lived  nearly  con- 
temporary with  the  great  Harvey,)  is  matter  of  sim- 
ple curiosity.  Old  medicine,  like  old  statute  law, 
must  of  necessity  become  obsolete.  The  conditions 
of  society,  and  the  measure  of  information  extant 
when  adopted,  render  them  of  little  value  after  the 
lapse  of  ages ;  and  any  progressively  improving  art 
or  science  can  be  but  little  indebted  to  its  first  projec- 
tors. 

From  Pare  we  may  date  the  origin  of  the  Obste- 
tric art.  He  brought  together  the  detached  facts  and 
opinions  which  were  spread  over  the  pages  of  a  crude- 


12 

medical  philosophy,  and  presented  it  in  the  form  of 
a  distinct  science  :  and  the  opportunity  afforded  by 
the  institution  of  public  hospitals  and  infirmaries  in 
his  time,  enabled  him  to  teach  a  more  rational  mode 
of  treating  the  parturient  woman,  than  any  who  had 
preceded  him.  The  progress  of  improvement  from 
this  point,  although  slow,  was  sure,  down  to  the  time 
of  Dr.  William  Hunter,  and  thence  onward  to  our 
own  day,  no  branch  of  medical  education  has  receiv- 
ed Greater  accessions  to  its  store  of  important  facts, 
or  made  more  rapid  advances  ;  till  we  may  say,  with- 
out danger  of  successful  contradiction,  that  its  princi- 
ples are  better  settled,  and  its  practice  more  rational 
than  at  any  previous  period. 

On  the  threshold  of  our  inquiry  into  the  nature 
of  our  vocation,  we  are  necessarily  directed  to  the 
physical  character  and  constitution  of  her  who  is  the 
subject  of  it.  The  knowledge  of  woman,  both  in  re- 
lation to  her  structure  and  her  functions,  is  so  essential 
to  a  full  understanding  of  them,  that  nothing  on  this 
interesting  branch  can  deserve  the  name  of  science 
which  has  not  this  for  its  basis  ;  and  indeed,  without 
it,  the  whole  is  worse  than  useless,  and  woman  would 
be  more  fortunate  in  being  favoured  with  our  neglect 
than  with  our  attention.  In  the  history  of  all  animal 
creation,  if  one  truth  can  be  said  to  be  more  obvious 
than  another,  it  is,  that  the  Creator  has  adapted  laws 


13 

for  every  living  being,  suited  to  the  necessities  of  its 
existence  ;  and  surely  woman  cannot  be  the  excep- 
tion. The  laws  of  her  being  have  destined  her  to 
become  a  mother ;  and  to  this  end,  long  before  she 
has  attained  maturity,  and  even  without  her  con- 
sciousness, the  powers  of  her  nature,  although  si- 
lently operating,  are  directed.  We  see  that  her  solid 
(bony)  structure  differs  from  that  of  the  man,  in 
shape,  in  consistence,  and  in  capacity ;  in  order  to 
qualify  her,  when  the  time  shall  come,  to  enter  upon 
that  interesting  relation,  with  safety  to  herself  and 
security  for  her  offspring.  We  observe  that  the  dis- 
tinction of  sex  is  but  one  of  many  differences  which 
exist  between  them,  and  that  on  her  part,  when  they 
do  exist,  they  all  concur  to  the  same  great  end.  Her 
system  of  nerves,  of  muscles,  and  of  blood-vessels, 
although  essentially  the  same,  are  marked  by  such 
striking  peculiarities,  as  scarcely  escape  the  most 
common  observation.  The  cellular  tissue,  which 
composes  by  far  the  largest  part  of  the  human  body, 
is  in  her  more  abundant  than  in  the  man,  and  the 
specific  gravity  of  her  whole  person  is  less.  Her 
muscles  are  less  strong,  and  possess  less  solidity ; 
her  nervous  system  is  more  sensitive,  her  circulation 
more  rapid,  and  every  part  of  her  structure,  from  its  pe- 
culiar nature,  independent  of  any  adventitious  cause, 

is  more  distensible  and  yielding,  in  order  to  provide, 
3 


14 

when  the  time  shall  arrive,  for  those  changes  which 
are  the  necessary  results  of  gestation ;  and  ensure 
her  health  and  safety  both  as  the  expectant  and  ac- 
tual mother.  She  but  obeys  a  law  of  her  being  in 
this  relation  :  and  He  who  made  her  has  provided  her 
with  constitutional  resources  suited  to  her  condition. 

Dr.  Adam  Clarke,  the  learned  and  ingenious  com- 
mentator, whose  skill  in  searching  out  the  geneolo- 
gies  of  proper  names  is  universally  acknowledged ; 
derives  the  term  woman  from  the  Saxon  word  womb- 
man,  or  man  with  the  womb  ;  and  he  takes  occasion 
to  say,  that  in  many  modern  languages,  the  term  sig- 
nifying woman  is  made  by  a  simple  feminine  termin- 
ation of  the  word  signifying  man ;  and  the  above  ac- 
count, short  and  imperfect  as  it  is,  is  in  perfect  accord- 
ance with  that  opinion.  She  is  man  with  a  womb,  and 
therein  consists  all  the  distinction ;  for  whether  she 
be  considered  morally,  physically,  or  intellectually, 
the  differences  are  all  to  be  referred  to  this  one  cause ; 
and  that  she  does  differ  in  all  these  respects,  even  in- 
dependent of  education,  is  pretty  generally  admitted. 

The  influence  of  sex  in  determining  the  moral  cha- 
racter is  strikingly  exemplified  by  a  comparison  of 
the  several  conditions  of  the  male,  the  female,  and  the 
eunuch.  The  emasculated  slave  of  the  Eastern  des- 
pot has  nothing  in  his  moral  nature  common  to  either 
sex.     The  physical  courage,  the  intellectual  vigour, 


15 

the  noble  daring,  the  strong  passion  belonging  to  the 
man ;  are  in  him  cowardice,  mental  imbecility,  child- 
ish timidity,  and  idiot  rage.     Compared  with  woman, 
we  find  that  the  refinement,  the  ingenuousness,  the 
excursive  fancy,  the  child-like  reliance  on  her  protec- 
tor, the  patient  endurance  under  suffering,  and  the 
elasticity  of  temper,  which  all  combine  to  render  her 
the  ornament  of  the  social,  and  the  delight  of  the  do- 
mestic circle,  are  alike  strange  to  his  heart  and  alien 
to  his  conceptions.    The  outcast  of  humanity  against 
his  will,  he   is   put  to  uses  fit  only  for  the  brute. 
"With  powers  of  intellect  too  barren  to  cultivate,  and 
capacity  for  enjoyment  but  little  more  expanded  than 
the  child's,  he  basks  in  the  sunshine  of  his  master's 
favour,  and  is  paid  the  wages  of  his  meanness  in  sen- 
sual indulgences.     Hybrid  in  body,  soul,  and  spirit, 
after  a  short  life  spent  in  employments  too  disgusting 
to  be  named,  to  which  neither  man  nor  woman  could 
be  debased,  he  falls  into  the  grave  unhonoured  and 
unwept. 

This  is  not  the  place  nor  the  occasion  to  pursue 
this  subject,  although  it  is  not  deficient  in  interest 
to  the  practical  physician.  The  necessary  and  re- 
ciprocal dependence  upon  each  other,  of  the  moral 
and  physical  natures,  is  too  obvious  to  need  illustra- 
tion ;  and  if  the  information  to  be  derived  from  this 
source  be  properly  improved  it  would  explain  some 
singular   apparent    anomalies   in  the   pathology  of 


16 

female  complaints.  I  am  not  willing  to  say  that  our 
moral  and  intellectual  powers  depend  essentially  on 
organization,  but  I  am  willing  to  believe  that  the  con- 
nection which  subsists  between  the  one  and  the  other 
is  so  constant  and  invariable,  as  to  warrant  us  to  con- 
clude that  they  depend  on  each  other;  and  the  lead- 
ing features  in  the  moral  aspect  which  the  female  sex 
presents,  as  distinct  from  the  male,  under  the  same 
measure  of  culture,  will  go  far  to  confirm  our  faith  in 
this  dependence. 

But  to  return  to  our  immediate  subject.  This  con- 
formity of  the  female,  both  in  structure  and  function, 
to  the  great  purpose  of  her  creation,  is  so  constant  and 
invariable,  under  all  circumstances  and  in  all  climates, 
in  all  healthy  conditions  of  the  subject ;  as  not  to  per- 
mit us  to  question  that  the  whole  process  of  repro- 
duction, so  far  as  the  female  is  concerned,  from  the 
first  moment  of  conception  to  its  final  consummation 
in  the  birth  of  the  offspring,  is  controlled  by  the  same 
natural  laws.  And  it  is  not  unreasonable  to  believe, 
that  in  the  primitive  stages  of  society,  very  little,  if 
any,  assistance  was  required  by  the  parturient  mo- 
ther, more  than  could  be  afforded  by  the  female  attend- 
ant who  had  passed  the  same  ordeal  before  her. 

We  have  the  best  authority  for  believing  that,  even 
at  this  day,  in  many  parts  of  India,  Africa,  and  Ame- 
rica, the  parturient  female  neither  wants  nor  needs 


17 

assistance.  When  her  painful  hour  arrives,  she  se- 
cludes herself  from  her  companions,  or  betakes  her- 
self to  some  retreat  sheltered  from  the  sun  and  wind ; 
bears  her  agony  in  silence,  as  if  impressed  with  its 
necessity,  and  the  conviction  that  sympathy  with  her 
sufferings  can  neither  prevent  or  mitigate  them ;  and 
after  a  short  period  returns  to  her  family  with  the 
object  of  her  solicitude  cradled  in  her  arms. 

Information  derived  from  the  Bible,  the  oldest  au- 
thentic record,  and  our  surest  guide  in  matters  of  fact 
as  well  as  in  points  of  faith,  permits  us  to  conclude, 
that  the  safety  of  the  parturient  women  was  almost 
exclusively  entrusted  to  their  natural  powers  ;  and  we 
are  assured  that  the  Hebrew  women,  during  the  first 
captivity  of  their  nation,  for  the  most  part,  had  no 
assistance  even  from  their  midwives,  for  it  is  recorded, 
that  the  midwives  whom  their  oppressor  ordered  to 
destroy  their  male  children,  answered,  that  it  was  not 
their  fault  that  they  were  not  destroyed,  for  that  the 
Hebrew  women  were  delivered  previous  to  their  in- 
terference. The  record  is  found  in  Exodus,  chap.  i. 
"  And  the  king  of  Egypt  called  for  the  midwives,  and 
said  unto  them,  why  have  you  done  this  thing,  and  have 
saved  the  men  children  alive  1  and  the  midwives  said 
unto  Pharaoh,  because  the  Hebrew  women  are  not  as  the 
Egyptian  women,  for  they  are  lively,  and  are  delivered 
ere  the  midwives  come  unto  them." 


18 

The  first  recorded  case  of  the  death  of  a  parturient 
woman  may  be  found  in  the  35th  chapter  of  Genesis, 
and  is  presumed  to  have  occurred  as  a  consequence 
of  great  fatigue  in  the  progress  of  a  tedious  journey, 
since  no  other  cause  can  be  inferred  from  the  text. 
Another  may  be  found  in  4th  chap.  1st  book  of  Sam- 
uel, and  it  occurred  under  circumstances  of  peculiar 
anxiety  and  mental  distress.  At  the  time  of  the  last 
event  the  world  was  3000  years  old :  generation  after 
generation,  for  all  that  period,  had  been  born  and 
consigned  to  the  tomb,  before  Midwifery  was  culti- 
vated even  as  an  art,  and  the  inference  is  a  very  natu- 
ral one,  viz.  that  the  process  of  parturition  needed 
little  of  its  assistance ;  for  if  it  had,  it  is  scarcely  pos- 
sible to  suppose  that  it  would  have  remained  so  long 
neglected. 

The  above  remarks,  with  the  accompanying  facts, 
will  serve  to  establish  the  great  principle  which 
ought  always  to  have  a  controlling  influence  over  the 
opinions  and  conduct  of  all  Obstetric  practitioners ; 
but  it  must  be  confessed,  that  it  presents  only  the 
bright  side  of  the  picture  ;  and  it  is  but  reasonable  to 
suppose,  that  many  perishedunder  circumstances  in 
which  the  ignorance  or  the  incapacity  of  their  female 
attendants  could  render  no  assistance. 

Nature  does  much ;  we  have  seen  that  she  provides 
for  emergencies  long  before  they  happen,  and  that 


19 

every  appointment  of  her  ordering  is  of  the  most  bene- 
ficent kind  ;  but  however  ample  the  provision,  we 
must  bear  in  mind  that  it  is  always  of  a  general  cha- 
racter, and  has  respect  to  the  subject  in  her  natural 
condition  only.  Deformity,  disease,  violence,  acci- 
dents, and  all  the  other  ills  that  "  flesh  is  heir  to," 
are  as  much  the  inheritance  of  the  female  as  of  the 
male  sex ;  and  it  is  to  them,  and  not  to  the  intrinsic 
difficulties  which  occasionally  attend  her  condition  as 
nurse  or  mother,  that  we  are  to  attribute  the  evils  she 
may  suffer,  or  the  dangers  against  which  it  is  our 
business  to  protect  her. 

These  are  the  causes  which  have  given,  and  will 
continue  to  give  to  Obstetrics  the  dignity  of  a  science, 
because  these  are  the  causes  which  render  the  con- 
dition of  our  female  patients  perilous  as  well  as  pain- 
ful. Besides,  the  female  is  the  subject  of  a  function 
which  has  a  controlling  influence  over  her  entire  sys- 
tem ;  its  organ  is  the  centre  of  more  sympathies  and 
associated  actions  than  any  other,  or  perhaps  all  others 
combined;  and  these  sympathies  vary  in  number 
and  degree  in  such  a  manner  as  to  defy  a  reference 
to  any  general  rule.  At  one  time  this  organ  is  per- 
fectly passive,  at  another,  particularly  sensitive  and 
active ;  and  these  various  states,  in  so  far  as  we  can 
judge,  are  accompanied  by  no  premonitions  by  which 
to  calculate  their  consequences.     It  varies  in  size,  it 


20 

differs  in  capacity,  and  it  occasionally  contains  within 
its  cavity  a  cause  of  sensation  and  of  irritation  to  her 
whole  system,  which  renders  her  liable  to  diseases 
and  accidents  from  which  our  sex  is  totally  exempt. 
In  the  gravid  uterus  the  system  is  called  upon  not  only 
to  repair  its  own  waste,  according  to  the  ordinary 
laws  of  life,  but  to  support  and  maintain  within  itself 
an  embryo  being,  which  possesses  nothing  indepen- 
dent of  her  for  its  sustenance,  but  the  principle  of  life. 
All  its  nourishment,  however  obtained,  whether  by 
imbibition,  digestion,  or  the  transfusion  of  her  own 
vital  circulation,  must  be  derived  from  her. 

Her  own  system  of  nerves  and  blood-vessels,  her 
whole  digestive  apparatus,  nay,  her  absorbent  and 
even  muscular  system,  in  so  far  as  the  muscles  of  the 
trunk  and  lower  extremities  are  implicated  in  the 
process  of  gestation  or  parturition,  are  subjected  to 
new  and  unwonted  sources  of  irritation  by  mechani- 
cal pressure  and  distension;  so  that,  but  for  the  known 
modification  of  the  ordinary  physical  laws  which 
govern  and  control  healthy  actions,  it  would  scarcely 
be  possible  to  suppose  that  she  could  continue  in  a 
state  of  health. 

The  diseases  of  early  life,  so  trifling  in  amount  as 
scarcely  to  claim  attention,  may  be,  and  frequently 
are,  so  serious  in  their  consequences,  as  to  render 
gestation  a  source  of  anxiety,  and  parturiency  preg- 


21 

tiant  with  danger.  A  chilblain  on  the  heel,  a  wound 
upon  the  toe,  the  injury  from  a  tight  shoe,  and  above 
all,  and  more  important  than  any,  the  discipline  of  a 
fashionable  boarding-school,  the  very  means  taken  to 
make  the  child  a  perfect  woman  in  figure  and  prcn 
portion,  may  in  certain  conditions  of  the  system  in 
younger  life,  be  sources  of  incalculable  mischief  when 
the  child  becomes  a  worn  an  $  and  that  woman  a  mo- 
ther. 

Derangements  of  the  functions  peculiar  to  the  fe- 
male may  so  impair  the  health,  as  to  render  gestation 
a  disease  and  immature  delivery  inevitable.  Malcon- 
formation  in  the  one  case,  haemorrhage  in  another ; 
awkward  presentations  in  a  third ;  misplaced  attach* 
ment  of  the  connecting  medium  between  the  mother 
and  the  child ;  convulsions*  and  various  other  causes 
which  I  need  not  here  enumerate,  as  they  will  all  claim 
our  attention  during  the  progress  of  this  course,  may 
place  the  lives  of  both  the  mother  and  child  at  haz- 
ard, and  call  for  the  exercise  of  a  judgment  to  avert 
the  dangers,  which  no  moderate  measure  of  acquire- 
ment can  furnish.  In  one  word,  diseases  in  all  their 
forms  may  supervene  during  the  progress  of  gesta- 
tion,  or  even  after  a  happy  delivery,  calculated  to  put 
in  requisition  all  the  resources  of  the  best  informed 
physician ;  and  it  is  in  these  and  similar  cases,  and 

they  are  by  no  means  uncommon,  that  all  the  science 
4 


22 

and  adroitness  of  the  most  skilful  Obstetrician  are 
required  to  be  exercised. 

There  are  conditions  for  which  unassisted  nature 
has  made  no  provision,  and  when  they  do  occur,  many 
of  them  must  suggest  their  own  rules  of  action  even 
to  the  most  intelligent  and  most  experienced.     For  a 
large  proportion  of  them,  however,  rules  of  practice 
have  been  adopted,  sanctioned  by  reason  and  con- 
firmed by  successful  experience.     What  those  rules 
of  action  are ;  what  are  the  reasons  for  their  adoption ; 
and  what  the  probability  of  success  in  case  they  are 
adopted ;  must  ever  remain  secrets  to  the  ignorant 
practitioner.     The  language  even  of  facts  in  Medi- 
cine or  Midwifery,  is  as  unintelligible  to  him  who  is 
ignorant  of  their   application,    as    the  language    of 
music  to  the  deaf,   or  of  colour  to  him  who  cannot 
see.     If  he  be  not  instructed  in  the  principles  of  the 
science,  the  language  addressed  to  his  outward  ears 
by  his  attendant  counsel,  will  be  as  barren  of  conse- 
quence as  if  addressed  to  an  idiot.  Conscience,  there- 
fore, as  well  as  common  sense,  counsels  every  man 
who  presumes  to  practice  our  profession,  to  qualify 
himself  for  its  duties,  before  he  enters  upon  their  ex- 
ercise,  and  it  is  to  this  great  purpose  all  medical 
education  is  directed. 

We  have  seen  that  the  great  principle  which  ought 
to  control  the  practice  of  the  Obstetric  art,  has  its 


23 

foundation  in  a  law  of  being.      Not  so  with  those 
which  are  subordinate.   These  must  be  derived  from 
study,    and  a  thorough  knowledge  of  the  structure 
and  functions  of  the  female,  if  they  be  necessary,  (a 
truth  which  none  will  deny,)  can  only  be  acquired  by 
a  diligent  application  of  the  means  which  all  well- 
regulated  schools  of  medicine  have  provided.     They 
have  been  already  stated,   and  it  is  therefore  unne- 
cessary to  repeat  them.     Obstetrics,  considered  both 
as  an  art  and  a  science,  and  they  are  so  closely  con- 
nected that  their  union  is  indissoluble,  ranks  second 
to  none  in  the  wThole  armoury  of  humanity  for  the 
mitigation  of  human  suffering  or  the  preservation  of 
human  life.     The  appliances  of  art  here  have  kept 
pace  with  the  improvement  of  science  ;   and  he  who 
presumes  to  practice  it  without  a  knowledge  of  both, 
or  a  reference  to  either,   as  unfortunately  is  some- 
times a  fact,  stands  justly  chargeable  with  the  conse- 
quences, not  only  of  all  the  errors  which  he  commits, 
but  with  the  disasters  which,  through  his  ignorance, 
he  is  unable  to  avert ;    his  ignorance  assumes  the 
character  of  crime,  because  the  most  expansive  cha- 
rity cannot  furnish  an  apology. 

But  such  is  the  folly  of  human  judgment;  the  per- 
verseness  of  professional  vanity,  and  the  imposture 
of  professional  cunning,  that,  notwithstanding  the  in- 
structions which  nature  teaches,  and  the  rules  which 


24 

circumstances  prescribe ;  the  patient  parturient  female, 
fully  confiding  in  the  resources  of  our  art,  often  be- 
comes the  victim  of  a  mistaken  or  vicious  practice. 
There  are  those,  whose  reliance  on  the  resources  of 
nature  are  so  entire,  that  they  anticipate  no  difficulty 
until  danger  presses,  and  when  it  does  press,  they  are 
left  without  the  expedients  which  a  proper  forecast 
would  have  enabled  them  to  exercise.  There  are 
others  who  think,  or  appear  to  think,  that  such  reli- 
ance impeaches  the  character  of  the  science ;  and 
that  to  wait  on  nature,  whose  operations  are  often- 
times tedious,  is  a  duty  too  degrading  for  their 
measure  of  acquirement ;  and  there  are  others  again, 
and  I  blush  to  name  them,  who,  without  any  reason 
derived  from  the  nature  of  the  case,  use  the  instru- 
ments of  their  art,  with  as  little  ceremony,  I  had 
almost  said,  as  they  would  use  a  lancet.  To  these 
three  classes  of  practitioners  the  malpractice  in  this 
part  of  our  profession  is  justly  attributable.  The 
circumstances  under  which  the  first  two  classes  pre- 
sent themselves,  admit  some  hope  of  amendment, 
but  the  last,  none.  To  the  first,  it  is  only  necessary 
to  say,  inform  yourselves. 

The  want  of  that  necessary  education  which  is  the 
ground-work  of  Midwifery,  is  one  which  we  might 
as  well  expect  nature  to  supply,  as  to  expect  it  to  be 
supplied   without    a    diligent   application   to    those 


25 

branches  of  the  science  which  alone  will  teach  it. 
The  knowledge  of  physical  conformation,  of  healthy 
function,  and  pathological  condition,  are  all  essen- 
tial to  form  estimates  of  consequences  in  cases  of 
difficulty ;  and  it  is  on  these,  and  these  only,  that 
the  practitioner  must  rely  for  that  measure  of  intelli- 
gence, which  will  enable  him  to  anticipate  them. 
Experience  may  do  something,  but  experience  itself 
can  teach  little,  when  the  pupil  is  deficient  in  that 
elementary  information  which  is  essential  to  under- 
stand  her  lessons. 

The  number  of  those,  who,  while  they  claim  to  be 
well  instructed  in  their  profession,  continue  to  teach 
and  practice,  on  the  assumption  that  Art  is  omnipo- 
tent, and  that  the  whole  of  midwifery  consists  in  the 
art  of  delivery,  we  have  a  right  to  believe  are  few,  in 
this  country;  but  in  Germany  they  abound.  From 
the  statistics  of  several  Hospitals  in  the  north  of 
Europe,  lately  published,  we  learn,  that  in  one  in- 
stance, as  many  as  one  in  five  parturient  women  were 
delivered  by  instrumental  assistance  ; — in  another, 
the  proportion  is  one  in  nine — in  another,  one  in 
fifteen — making  the  average  proportion,  when  com- 
pared with  the  practice  of  the  London  and  Dublin 
lying-in  wards,  as  ten  to  one;  so  that  while  the 
proportion  of  instrumental  deliveries  in  the  last  men- 
tioned places  is  as  one  to  one  hundred,  the  proportion 


26 

in  the  German  Hospitals  is  10  per  cent,  of  the  whole 

number. 

This  disparity  cannot  arise  either  from  accident  or 

ignorance,  but  must  find  its  explanation  in  the  cause 

above  stated. 

It  is  not  my  duty,  and  certainly  it  is  not  my  design, 
to  censure  with  unmerited  severity,  these  palpable  per- 
versions of  the  resources  of  our  Art,  but  we  may  say, 
without  hesitancy,  that  such  an  excessive  proportion  of 
instrumental  deliveries,  has  heretofore  been  unknown, 
in  any  age  or  country.  It  is  a  remarkable  fact,  that 
this  practice  obtains  in  the  same  section  of  the  world, 
where  the  doctrines  of  Homoeopathic  medicine  pre- 
vail. If  they  are  inconsistent  with  themselves, 
however,  it  is  no  more  than  would  be  expected, 
as  both  are  inconsistent  with  nature  :  they  are  at- 
tempts to  be  "  wise  above  what  is  written,"  and  the 
results  of  a  knowledge  derived  from  an  experience  so 
limited,  as  not  to  deserve  the  name:  instrumental 
practice  in  Midwifery,  and  Homoeopathic  medicines 
for  recovery,  would  appear  to  leave  nothing  which  a 
sound  philosophy  can  either  approve  or  applaud. 
The  cure  of  this  Obstetric  heresy,  if  it  admits  a  cure, 
must  be  left  to  time  and  to  experience :  the  unfortu- 
nate results  which  must  attend  this  practice,  cannot 
fail  to  correct  it. 

Of  that  class  of  practitioners  here  and  elsewhere, 


27 

who  causelessly  use  the  instruments  of  our  Art,  we 
cannot  speak  in  respectful  terms,  and  do  justice  to 
our  subject.  Both  reason  and  conscience  unite  to 
reprobate  a  practice  which  has  nothing  which  even 

appears  to  palliate  it :  they  may  be,  and  without 
doubt  are,  more  proper  subjects  for  moral  reform 
than  for  medical  instruction.  With  such  men  I  trust 
none  of  you  can  hold  communion. 

He,  who,  in  the  character  of  an  Accoucheur,  can, 
without  a  distinct  reference  to  the  patient's  relief, 
add  one  pang  to  the  sufferings  of  the  parturient  fe- 
male, which,  so  far  as  we  know,  the  Author  of  her 
being  has  intended  for  a  memento  of  her  mortality, 
cannot — ought  not  to  claim  any  rank  in  our  pro- 
fession :  the  retribution  for  his  offences  may  be  slow, 
but  it  must  be  certain ;  and,  come  when  it  may,  in  the 
conflict  with  conscience,  he  must  become  the  victim 
of  a  bitter  remorse. 

Before  I  close,  I  would  address  one  word  to  those 
of  my  audience  who  are  candidates  for  the  honours 
of  the  medical  profession.  From  the  few  remarks 
which  I  have  had  the  honour  to  submit,  you  may 
form  a  tolerably  correct  idea  of  your  vocation  ;  you 
can  estimate  its  importance,  and  you  may  judge  of 
the  extent  of  acquirement  necessary  to  fulfil  its  duties. 
In  the  course  of  your  future  practice,  you  will  be 


,21 

called  to  employ  all  the  talents  which  you  may  pos* 
sess,  and  all  the  experience  which  yon  can  borrow  ;■ 
and  find,  at  last>  that  the  sum  total  of  both  is  insuffi-' 
cient  for  the  occasional  exigencies  in  which  you  may 
be  called  to  act,  as  others  have  found  before  you. 
You  will  be  placed  in  circumstances,  in  which  your 
feelings  and  your  duty  may  seriously  conflict,  and 
the  practice  of  Midwifery  frequently  presents  such 
occasions. 

If  you  would  have  that  confidence,  without  which 
you  can  never  inspire  any  in  your  patients ;  for  none 
will  willingly  trust  those  who  will  not  trust  them- 
selves ;  if  you  would  be  armed  for  all  emergencies, 
qualify  yourselves  by  diligent  application  to  study. 

A  Sophomore  physician  is  a  dangerous  man.  The 
means  placed  at  your  disposal  are  ample,  and  yott 
will  be  left  without  apology,  if  you  neglect  them. 

Remember  that  ignorance,  in  its  medical  sense,  is 
crime,  when  opportunity  for  information  has  been 
afforded,  because  its  consequences  frequently  admit 
of  no  reparation ;  whereas  in  all'  other  professions 
and  employments,  mistakes  may  be  corrected  :  this 
single  consideration  should  give  to  the  practice  of  our 
profession,  a  moral  sanction,  stronger  than  any 
which  human  law  can  prescribe. 


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